title: Predicting the prognosis in acute liver failure: results from a retrospective pilot study using the LiMAx test.
abstract: BACKGROUND
  Acute liver failure (ALF) is a rare but potentially life-threatening condition and liver transplantation (LTX) remains frequently the only effective therapy. Nevertheless, some patients recover without LTX but the individual indication for or against LTX remains difficult.
  
  
  OBJECTIVE
  To evaluate maximal liver function capacity (LiMAx) for predicting the prognosis of ALF. Material and methods. Clinic data of 12 patients was retrospectively analyzed to compare the different liver function test results with the patients' clinical outcome. Patients were assessed by the LiMAx test, a non-invasive breath test determining cytochrome P450 1A2 capacity using intravenous 13C-methacetin. Statistical analysis compared patients with spontaneous recovery versus non-recovery (LTX or death).
  
  
  RESULTS
  Twelve patients (6 male, 6 female; 49 [11-72] years) with viral hepatitis (n = 2), toxic liver injury (n = 3), or cryptogenic liver failure (n = 7) were analyzed. Seven patients fully recovered from ALF and were discharged without LTX. Three patients died and two underwent LTX. The King's College Criteria (KCC) was fulfilled in only one out of five patients without recovery. The LiMAx was 19 ± 19 (16-62) for non-recovery vs. 94 ± 119 (39-378) μg/kg/h for recovery (P = 0.018). In contrast, all biochemical parameters [bilirubin (P = 0.106), creatinine (P = 0.343), AST (P = 0.53), ALT (P = 0.876) and INR (P = 0.876) were statistically indistinct. Also the Model for End-Stage Liver Disease (MELD) score did not show a difference [35 ± 4.3 (29-40) vs. 30 ± 11.5 (6-40); P = 0.27].
  
  
  CONCLUSIONS
  Maximal liver function capacity determined by LiMAx test is severely impaired in patients with ALF. The LiMAx test might be effective in predicting the individual prognosis and the need for LTX in ALF.
authors.affiliation: Department of General, Visceral and Transplantation Surgery, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany.
authors.forename: Johan Friso
authors.initials: JF
authors.lastname: Lock
authors.forename: Amir Nihad
authors.initials: AN
authors.lastname: Kotobi
authors.forename: Maciej
authors.initials: M
authors.lastname: Malinowski
authors.forename: Antje
authors.initials: A
authors.lastname: Schulz
authors.forename: Maximilian
authors.initials: M
authors.lastname: Jara
authors.forename: Peter
authors.initials: P
authors.lastname: Neuhaus
authors.forename: Martin
authors.initials: M
authors.lastname: Stockmann
mesh_terms: D000081:Acetamides / Q000008:administration & dosage; D000293:Adolescent; D000328:Adult; D000368:Aged; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D001944:Breath Tests; D002648:Child; D019388:Cytochrome P-450 CYP1A2 / Q000378:metabolism; D005260:Female; D006801:Humans; D019934:International Normalized Ratio; D017114:Liver Failure, Acute / Q000097:blood / Q000175:diagnosis* / Q000201:enzymology / Q000401:mortality / Q000601:surgery; D008111:Liver Function Tests / Q000379:methods*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D020127:Recovery of Function; D012189:Retrospective Studies; D013379:Substrate Specificity; D013997:Time Factors; D055815:Young Adult
chemical_list: D000081:Acetamides; D015415:Biomarkers; C035495:methacetin; C504573:CYP1A2 protein, human; D019388:Cytochrome P-450 CYP1A2